ISCHEMIA trial follow-up: a review

The ISCHEMIA trial compared two strategies for patients with chronic coronary disease and moderate to severe ischemia: conservative management versus invasive management. However, no major differences were discovered after a follow-up of around 3.2 years. After 5.7 years, there was seen to be a lower risk of cardiovascular mortality with the invasive strategy. However, there was also noted a higher risk of non-cardiovascular mortality. These results are predicted to be maintained after 7-10 years. During this experiment, after the 3.2 year follow up, only mortality was tracked. Other information such as medication, quality of life or revascularisation were not noted for the patients involved. Despite this missing data, this ISCHEMIA trial provides useful information for both patients and clinicians in understanding methods of guideline-directed medical therapy for chronic coronary disease.

This review by Hochman J et al. aimed to understand how conservative management and invasive management compared in long-term support of patients with chronic coronary disease and ischemia.

Key learnings:

A version of this trial called the ISCHEMIA-EXTEND will continue following up with the surviving participants of this study into 2025. This will allow for more precise understanding about the mortality estimates for these patients, and better inform clinical guidance surrounding chronic coronary disease and ischemia.